A study of ex-prisoner female narcotic addicts in Hong Kong

Sections

Introduction
Female Narcotic Addicts
Causes of addiction
Summary and conclusion
Reference

Details

Author: L. K. DING , , L. Y. CHAN
Pages: 7 to 11
Creation Date: 1970/01/01

A study of ex-prisoner female narcotic addicts in Hong Kong

L. K. DING *,
L. Y. CHAN **

Introduction

Narcotic addiction is one of the most serious social, economic and medical problems in Hong Kong. Although the actual number of addicts is not known, workers in the field estimate it to be between 60,000 and 80,000. Since the total population in Hong Kong is approximately 4 million, this means then that I out of every 50 or 70 persons in Hong Kong is an addict. There are some 2,000 addicts in the United Kingdom and about 100,00 addicts in the United States of America, and against these figures the enormity and seriousness of the problem Hong Kong faces is self-evident. Furthermore the majority of the Hong Kong addicts are addicted to the "hard" drugs, namely, heroin or opium. More than 80% of the prison population in Hong Kong are addicts; in 1968, 13,678 persons were arrested for offences connected with narcotics, and of these over 12,193 were convicted.

An addict consumes an average of HK$ 10.00 ($6.05 H.K. = $1.00 U.S.) worth of narcotics drugs per day. It is thus estimated that over HK$ 250 million are spent on narcotic drugs by addicts every year, an amount which is nearly double the annual Government budget for the total medical services for the city, or more than 10% of the total Hong Kong Government budget for the year 1968/1969. Narcotics are within easy reach of every addict because of the large quantifies that are smuggled into the city from South East Asia. Not long ago, during a public ceremony the Government burned 5 tons of confiscated opium, morphine and heroin; only very recently another 2 tons of confiscated narcotics were also burned publicly.

Female Narcotic Addicts

It is estimated that female addicts constitute 3 to 5% of the total addict population in Hong Kong. In other words there are between 2,000 and 5,000 female narcotic addicts in Hong Kong. Until the Discharged Prisoners' Aid Society started a modest treatment centre for female addicts in April 1967, no properly organized work was being done for these female addicts. Since one of the main objectives of this Society is the rehabilitation of discharged prisoners, and since a large number of discharged female prisoners are addicts, the Society felt that there was a great need to set up a treatment and rehabilitation centre for female addicts, who were taking drugs surreptitiously while still in prison, or who promptly relapsed to narcotics abuse after discharge.

Hon. Medical Advisor, Hong Kong Discharged Prisoners' Aid Society. Plummer Diagnostic Laboratory, 566-68. Nathan Road, Kowloon, Hong Kong.

Medical Assistant, Hong Kong Discharged Prisoners' Aid Society. Plummer Diagnostic Laboratory, 566-68 Nathan Road, Kowloon, Hong Kong.

The centre consists of an ordinary apartment in a private multi-story building sufficient to accommodate only 12 persons at a time. It was started as a pilot project to see if female narcotic addicts could be treated for a short period of 2 months in a drug free environment, followed by intensive after care work, consisting mainly of social rehabilitation such as attempts at family reconciliation, job training and procurement of employment. All those admitted to the centre came of their own volition. They were interviewed by the social case workers followed by a routine physical examination, including blood studies and X-ray examination of the chest. Anyone was eligible for admission provided she was a discharged prisoner without any infectious diseases such as open tuberculosis. Oral methadone substitution therapy was used for the period of acute withdrawal lasting less than 2 weeks in general. The starting dose of methadone was never more than 20rog per day, and it was rapidly reduced and completely withdrawn by the end of one week to ten days. This report is based on 109 discharged female prisoner addicts treated at the centre between April 1967 and December 1968.

TABLE 1

Age at the time of first addiction

Age (years)
Number of persons
13 2
15-20
7
21-25
24
26-30
38
31-35
23
36-40
10
41-45
4
49 1
TOTAL
109

Comments: although the greatest number (85) became addicted in the ages ranging between 21 years and 35 years, it is significant to point out that 9 persons became addicted while they were below 20 years of age, and 2 while they were only 13 years old. Both of these two were students at the time of initial addiction. The small number of younger addicts in this study does not reflect the true picture of addiction among the teen-agers, as it is generally known that very few younger addicts would volunteer for treatment, for the simple reason that they can easily support their habit by engaging in prostitution- something which is not easy for the older female addicts to do.

TABLE 2

Age at time of Admission to the Treatment Centre

Age (years)
Number of persons
15-20
4
21-25
1
26-30
4
31-35
11
36-40
31
41-45
29
46-50
15
51-55
9
56-60
2
61-65
3
TOTAL
109

Comments: this table shows that the largest number of female addicts who volunteered for treatment came from the group ranging in age between 31 and 50 years. In the previous table it was noted that the greatest number of females became addicted while they were between 21 years and 35 years old. The youngest in this study was 15 years old, and oldest 63 years old when they volunteered for treatment.

TABLE 3

Duration of Addiction

Duration (years)
Number of persons
1-3
3
4-6
3
8-12
47
13-16
34
17-20
21
21-24
1
TOTAL
109

Comments: a simple calculation based on the figures in this table shows that these 109 addicts had been taking narcotics for a total of 1,400 years, averaging 12 years per person, spending a total of at least HK$ 6,000,000 during this period, or nearly 'HK$. 60,000 per person. This is a very conservative estimate based on the average consumption of only $10 of drugs per person per day.

TABLE 4

Level of Education

Educational level,
Number of persons
Teacher training
1
Secondary school
5
Primary school
41
Illiterate
62
TOTAL
109

Comments: the high rate of illiteracy among these female addicts is in great contrast to a group of 446 male ex-prisoner addicts studied by the authors (l), in which group there were only 52 illiterates. This is not at all surprising because of the traditional prejudice of Chinese parents against educating their daughters. As more and more juveniles are getting involved in narcotics in recent years in Hong Kong, this illiteracy rate is expected to change in any future study, as there is non less parental bias against educating girls.

TABLE 5

Occupation

Type of occupation
Number of persons
Prostitution
88
Narcotic peddler
5
Pick-pocket
5
Bar-girl
1
Gambling Den attendant
1
Housewife
3
Unknown
6
TOTAL
109

Comments: of the 88 prostitutes 57 were first addicted to narcotics before becoming prostitutes. Similarly the 10 narcotic pedlars and pick-pockets were first addicted before becoming involved in criminal activities. It can be seen that prostitution affords the easiest means for a large majority of female addicts to maintain their habit. One addict revealed that she had been a prostitute for 6 years. Her average number of customers was 25 a day with a maximum of 60 a day. Each customer paid $5 from which $3 was deducted for the procurer and for other expenses, leaving only $2 for the woman herself. After spending $35 per day to buy narcotic drugs, there was often not much left for her other living .expenses; for example, if she became ill, she would have to borrow money from friends. For the very young addicts who command a better price from their customers, money is often not a problem, which again explains why so few young addicts volunteered for treatment in this study. The older addicts who cannot practise prostitution, are compelled to become procurers themselves or narcotic pedlars etc.

TABLE 6

Marital status

Marital status
Number of persons
Married
9
Widowed
12
Co-habitation
88
TOTAL
109

Comments: according to this study only 21 claimed to have been married or widowed. Of those who claimed to be widowed at least half were known to have been deserted by their husbands, because of their addiction. Of the 88 persons who admitted to be co-habitating with others 5 began this relationship before they were 16 years old. More than 70 % of these 88 persons were separated from their sexual partners after 3 years. At least 20% of their male partners were also drug addicts. Some cases were living with more than one male partner at the same time.

TABLE 7

Incidence of venereal disease

Number of VDRL tests
Number of positive tests
92
45 (48.8 %)

Comments: in view of the large number of prostitutes in this group of addicts the large number of positive tests is not at all surprising. It is of interest to point out that in another study of 294 male ex-prisoner addicts tested for venereal disease only 61 (20.8%) gave positive results. The public health hazard this group of infected female addicts presents is quite evident, though it is another problem.

TABLE 8

Method of drug usage

Method
Number of persons
Inhalation:
 
"Shooting the ack-ack gun"
15
"Chasing the dragon "and" Playing the mouth-organ
34
Intramuscular injection
23
Intravenous injection
37
TOTAL
109

Comments: in this group of 109 addicts without exception heroin was the only drug used. A novice usually starts by "shooting the ack-ack" in which some heroin powder is placed at the end of a cigarette which is then held in the mouth pointing the cigarette skyward before it is lighted to prevent the loss of the powder. The addict then progresses to either "chasing the dragon" or "playing the mouth-organ ". In both methods the heroin powder, either mixed or unmixed with barbitone or by itself, is placed on a piece of tin foil cigarette wrapper, and is heated by means of a small flame from a taper made of toilet paper or newspaper. As the powder evaporates it rises as a stream of smoke in the shape of an imaginary sinewy "dragon' which is then "chased" by means of a round hollow tube made of paper held in the mouth. Holding the outside cover of a matchbox in the mouth to inhale the heroin smoke is "playing the mouth-organ ". This latter method is more efficient as most of the smoke is inhaled with little loss. Intramuscular and intravenous injections need no further comment. Here it is of interest to compare the much larger number of female addicts, 60 or 55% who used injections with only 7 male addicts (47o) out of 174 studied. The reason for this much larger number of female addicts using injections is not clear, though the sample of these female addicts is rather particular in its characteristics, and the high use of injections may be yet another peculiarity in the sample.

TABLE 9

Imprisonment records

Number of imprisonments
Number of persons
1-3
49
4-6
40
7-9 .
8
10-13
8
17-27
4
TOTAL
109

Comments: since this group of addicts were all discharged prisoners the imprisonment records could be easily verified. The common offenses for which they were convicted included possession of dangerous drugs and in many cases also soliciting for immoral purposes. Gaol terms may vary from one week to a few years. It is a matter of common knowledge that some addicts continue to get their supply of drugs surreptitiously while in prison. The prison records in the table show the futility of imprisonment in coping with the problem of drug addiction.

Causes of addiction

Information regarding the initial cause or causes of addiction is most difficult to obtain for often addicts would give different reasons to different workers at different times. In general it can be said, for those in the younger age group, especially those under 25 years of age, that they were often introduced to the drug by their boy friends, who were themselves drug addicts. These male partners often deliberately induced their girl friends to the habit so that they could make use of them to practise prostitution in order to earn money to support their habit.

Thus young bar girls and dancing hostesses are most vulnerable to this vice. News of young male addicts being charged in court for living on the earnings of prostitution is quite common in Hong Kong. Sometimes these young male addicts have several prostitutes under their control.

The women in our sample who first became addicted when middle-aged or older were often from rather well-to-do homes. They were either wives, mistresses or concubines of wealthy people, who used to serve opium in their homes as a method of entertaining their guests. These women, many from the mainland of China, changed from opium to heroin after they came to Hong Kong.

A rather small group of addicts became addicted because of painful diseases such as peptic ulcer. Another minor reason is fatigue arising out of long working hours in factories. One of the two girls who became addicted at the age of 13, was still in school at the time of initial addiction. She began by going to parties in the homes of schoolmates. They then moved their parties to the dance halls and then to lodging houses. Before long she was addicted. By the time the parents found out it was quite late. She had been addicted for more than a year. From her earnings through prostitution she supported not only herself but also several of her boy friends who were also addicts. This is a typical story of some of the young addicts.

TABLE 10

Treatment results

 
Number of persons
Completed 2 months treatment
78
Prematurely discharged
7
Left the centre of their own will
20
Still in the centre at the time of this report
4
TOTAL
109

Comments: 27 (25%) of the total number (109) admitted for treatment failed to complete the two months treatment; 20 left the centre of their own will, because they could not withstand the discomfort of the withdrawal symptoms in spite of substitution therapy, or, they felt well enough to leave before the two months period was up; and 7 had to be discharged by the staff prematurely because of disruptive behaviour.

TABLE 11

Follow-up results

 
Number of persons
Remaining abstinent
10
Lost contact
10
Known to have relapsed
58

Comments; of those 58 who are known to have relapsed 23 relapsed within the first month after discharge; 16 after 2 months; 8 after 3 months; 4 after 4 months; 3 after 5 months and one each after 6, 7, 8, 11 and 15 months. It is in fact surprising that 10 out of 78 remained abstinent when the background of their addiction and the short period of treatment are considered. Of these 10 who are still abstinent 2 have remained so for more than 2 years, 2 for over 18 months, 2 for over 12 months and 4 for more than 6 months. Analyses of these 10 persons who were abstinent showed that their ages ranged between 30 and 57 and the duration of addiction averaged 14 years with a minimum of 8 and maximum of 24 years; 4 of these had been mainliners while 3 of the remaining "chased the dragon" and 3 "shot the ack-ack "; 5 claimed the cause of their addiction to be some painful illness, 3 said it was curiosity and 2 attributed it to temptation by others; 3 are illiterates; 5 have finished primary school and 2 secondary education. It is of interest to point out that 7 who were former prostitutes now have respectable occupations: 3 work as maid-servants, and 4 have become housewives. One who was a former drug pedlar and another who had been a pick-pocket both now have jobs as maid-servants. The tenth person was a former housewife and has remained so. A study of the characteristics of those who have relapsed as compared with the above 10 persons so far reveal no clue as to the reasons for success and failure.

Summary and conclusion

Heroin addiction remains a most serious problem in Hong Kong with 60,000 to 80,000 addicts in a total population of 4 million. These addicts consume $250 million (H.K.) worth of narcotic drugs a year, equivalent to 10% of the total government budget. Though the majority are male addicts at least 3 to 5 % are female addicts for whom no organized treatment was available until a pilot project was started by the Discharged Prisoners' Aid Society in April 1967.

This paper reports some of the characteristics of 109 female discharged prisoners who were addicted to heroin, and evaluates the results of treatment for a short period of time, namely, two months in a drug free environment followed by social rehabilitation. Though the relapse rate is very high (68 out of 78) the 10 (12.8%) that still remains abstinent is quite gratifying in view of the type of addicts dealt with and the short period of treatment.

Reference

L. K. Ding et al., Three Years Experience with Short-term Treatment of Ex-prisoner Narcotic Addicts (to be published).